Chronic Lumbar back pain (CLBP) is one of the most common chronic pain conditions resulting in both individual suffering and a burden to societies. For these patients there are several interventional treatment options such as surgery, blocks, radiofrequency, and spinal cord stimulation. Lately also Dorsal Root Ganglion Stimulation (DRG-S) has been mentioned as an option, by targeting bilateral T12 dorsal ganglia. In this study we will present the outcome of 11 patients with CLBP treated with bilateral T12 DRG-S.
13 patients with CLBP with and without leg pain were treated with bilateral T12 DRG-S. Three of the patients also received a third lumbar lead due to leg pain. 11 of the patients had a more than 50% pain relief during the per- or/and postoperative testing and received a fully implantable neurostimulator. Pain intensity, general health status, quality of life, pain catastrophizing, mental status, sleeping disorder, physical activity and patient satisfaction were followed using NRS, PROMIS-29, PCS, GAD-7, PHQ-9, ISI and patient satisfaction questionnaire at baseline before implantation, 3 months and 6 months. The results were analyzed based on 6 domains: pain relief, sleeping disorder, social ability, mental status, physical activity, and satisfaction. To be identified as a responder the patients should show a significant improvement in the pain relief domain together with at least two other domains. All responders were given the opportunity to test 4 Hz DRG-S and compare it with traditional 20 Hz stimulation.
All 11 patients were identified as responders at six months. 5 of the patients had a more than 80% pain relief with an average NRS score reduction of 71 % for the whole group. Significant improvement could be observed in 3 domains for one patient, 4 domains for three patients, 5 domains for six patients and 6 domains for one patient. Seven patients chose to try 4 Hz stimulation. All seven identified 4 Hz stimulation at least as good or better than 20 Hz stimulation and chose to continue with 4 Hz stimulation.
Bilateral T12 DRG-S seems to be an effective treatment for chronic low back pain with significant beneficial effect not only on pain but also on quality of life, pain catastrophizing, mental status, sleeping disorder and physical activity. 4 Hz DRG-S gave comparable or better result than 20 Hz stimulation.
T12 level could be a good target for DRG-S for CLBP. 4Hz DRG-S seems to be at least as good as 20Hz.
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1. DRG-S could be a valuable treatment option for patients suffering from CLBP.
2. DRG-S have beneficial effects not only on pain but also other health metrics.
3. 4 Hz DRG-S seems to have comparable or at least as godd effect as 20 Hz stimulation.